Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, April 14, 1995 TAG: 9504140023
SECTION: VIRGINIA PAGE: B-4 EDITION: METRO
SOURCE: FROM STAFF AND WIRE REPORTS
DATELINE: LENGTH: Medium
The pilot program, a prelude to the statewide privatization of Medicaid, is a response to legislation passed by this year's General Assembly and signed by Gov. George Allen. State Medicaid officials also are required to come up with a long-term plan by September for taking Medicaid managed care statewide.
In three or four years, Medicaid recipients throughout Virginia will be receiving their care through HMOs or related managed-care organizations, said Robert Metcalf, director of the state's Department of Medical Assistance Services, the agency that administers the program. Excluded from the HMOs would be recipients who are eligible for long-term care services, such as nursing home care.
The care provided Medicaid clients will be tracked by computer with the help of the Williamson Institute of the Medical College of Virginia and by an external review organization still to be selected.
Quality report cards on participating HMOs are planned after the first year.
Clients will be given a choice of three or four HMOs to join, and those who don't make a choice will be assigned to a company. The HMOs will be paid a set amount in advance to provide the care.
A number of states have started similar programs recently in attempts to curtail rapidly rising costs of their Medicaid programs, which are health coverage plans for indigent people that are funded by the state and federal governments.
Virginia's Medicaid budget is about $2 billion a year, or about 12 percent of the total state budget, and is the fastest-growing area of state expenditures, Metcalf said.
Currently, 320,000 of the state's 500,000 Medicaid clients, mostly women with children, are in a primary care provider group called Medallion. The Roanoke Valley has about 11,000 enrolled.
Some 2,000 physicians statewide - family practitioners, obstetricians, internists - direct or manage the Medicaid clients' care, including deciding when referrals to specialists are necessary. The progam is active in most urban areas; recruitment of physicians to participate has gone more slowly in rural areas such as Southwest Virginia, Metcalf said.
In addition to fees for their services, the doctors are paid $3 a month per patient.
Savings have been between 5 percent and 6 percent, Metcalf said.
Managed care plans, such as HMOs, have been touted by many employers for their ability to keep health-care costs in check. HMO patrons generally have fewer hospitalizations, fewer referrals to specialists and fewer emergency room visits than conventionally insured people. A primary-care physician directs, or manages, each patient's care, including referrals.
HMOs have a financial incentive to keep costs in check because they receive a set amount of money in advance from employers and others who contract with them to provide medical services.
by CNB